Acute Ischemic Stroke

Acute ischemic stroke is a neurologic emergency characterized by an acute oxygen supply and demand mismatch, caused by either thromboembolism, atherosclerotic lesions, or hypoperfusion, leading to sudden-onset neurologic deficits that localize to the affected vascular territory. The mnemonic BEFAST—balance (limb ataxia), eyes (vision loss), face (facial droop), arms (asymmetric arm weakness), speech (dysarthria or aphasia), and time (acute symptom onset)—provides a framework for common stroke symptoms. New-onset stroke symptoms mandate emergent evaluation with a neurologic exam, laboratory studies, and a head computed tomography (CT). Patients with disabling symptoms presenting within 4.5 h of last known well (LKW) without contraindications may be eligible for thrombolysis (alteplase or tenecteplase). Patients presenting with disabling symptoms within 24 h of LKW and who are found to have a large-vessel occlusion may be eligible for intra-arterial thrombectomy. After acute therapy, patients should be initiated on secondary stroke prophylaxis based on the underlying stroke etiology.